Growing numbers of physicians are adopting point of care ultrasound (POCUS) without having trained in cardiology or radiology. To avoid diagnostic error it is necessary to ensure that they have the requisite skills not only in image acquisition and interpretation, but also in understanding what constitutes diagnostic image quality (DIQ) so that they can identify whether their acquired images are good enough to make a diagnosis for a given patient's clinical presentation. The objective of the present proposal is to develop 1) a rubric for quantifying the diagnostic quality of images acquired on live patients, and 2) a safe-POCUS tool that implements the rubric on the Skills Assessment System (SAS), a simulator developed at the University of Washington for training and assessment of ultrasound skill. We will begin with cardiac ultrasound but this technology will be applicable to ultrasound of other organs. The assessment of DIQ bridges the gap in programs that only teach image acquisition and image interpretation. The proposed rubric and safe-POCUS tool will enable efficient training in DIQ, an essential skill that is difficult for physicians to learn from abbreviated POCUS trainin programs. The rubric and safe-POCUS tool will contain weighted criteria not only for DIQ of standard views, but also and more importantly, DIQ required for key diagnoses. We will also develop Dynamic Guidance, a novel instructional tool, to visually demonstrate to physicians how manipulating the transducer and adjusting equipment settings helps achieve DIQ. We will develop a curriculum on the SAS to teach and assess skill in DIQ. We will then assess the impact of the DIQ curriculum on patient safety by comparing the ability of physicians with vs. without DIQ training to correctly distinguish images of adequate vs. inadequate quality for diagnosis. HEALTH CARE BENEFIT: This research is significant for patient safety because competence in acquiring images of diagnostic quality may reduce false negative and false positive diagnoses from POCUS, and help physicians maintain skills over time and on limited patient volumes and thereby enhance the safe and effective utilization of ultrasound in their practices.